Article

Irrespective of treatment history, shoulder dysfunction may occur in
children with neonatal brachial plexus palsy. Following internal contracture
release and/or muscle tendon transfer (ICR/MTT) shoulder function gain is
possible. This study describes the outcomes of ICR/MTT for children with neonatal
brachial plexus palsy, with or without prior nerve surgery (a group with prior
nerve surgery and a group without prior nerve surgery). METHODS: The study included children who underwent an ICR/MTT with a minimum follow-up of 6
months. Active/passive range of motion (aROM/pROM)/Mallet scores were recorded
(pre-operatively, 6 months, and 1, 3, 5 and 10 years post-surgery). Changes over
time within groups were analysed using a linear mixed model. RESULTS: A total of
115 children (60 boys) were included, 82 with nerve surgery history, mean age 4.7
years (standard deviation (SD) 3.3 years), mean follow-up 6 years (SD 3.2 years).
Pre-operatively active external rotation, abduction and forward-flexion were
worse in the group with prior nerve surgery. aROM, pROM and Mallet scores,
improved at all time-points in both groups. The course and magnitude of these
improvements were largely similar in both groups. In the long-term, the effects
of ICR/MTT decrease, but remain significant. CONCLUSION: In children with
neonatal brachial plexus palsy shoulder function improved after ICR/MTT,
irrespective of treatment history. Pre-operative shoulder function was worse in
the group with prior nerve surgery, resulting in less function in this group
after ICR/MTT. Reporting on outcome after secondary shoulder surgery should be
stratified into children with and without prior nerve surgery, in order to
prevent over- or underestimation of results. LEVEL OF EVIDENCE: This study
concerned a retrospective treatment case series study. LEVEL OF EVIDENCE: IV.

Langue : ANGLAIS